Concurrent splenic and renal infarction in scrub typhus: expanding the vasculitic spectrum

BACKGROUND: Scrub typhus is a mite-borne zoonotic infection caused by Orientia tsutsugamushi, characterized by systemic vasculitis and multiorgan involvement. While hepatic, pulmonary, and renal dysfunction are well recognized, ischemic infarction of solid organs is distinctly uncommon. CASE PRESENTATION: A 35-year-old previously healthy woman presented with acute febrile illness, respiratory symptoms, and left upper-quadrant abdominal pain. Examination revealed tachypnea, hypoxia, and focal abdominal tenderness without rash or eschar. Laboratory evaluation showed neutrophilic leukocytosis, thrombocytopenia, elevated transaminases, and raised inflammatory markers. Scrub typhus IgM enzyme-linked immunosorbent assay was positive using a validated regional cut-off. Contrast-enhanced computed tomography of the abdomen demonstrated wedge-shaped, non-enhancing hypodense areas in the spleen and right kidney, consistent with splenic and renal infarctions. Comprehensive evaluation excluded cardiac embolic sources, coagulopathy, and autoimmune or hypercoagulable conditions. The patient was treated with intravenous doxycycline and azithromycin, with rapid clinical improvement and complete recovery. CONCLUSION: This case expands the vascular spectrum of scrub typhus by demonstrating concurrent splenic and renal infarction, likely due to disseminated vasculitic and microangiopathic injury. Clinicians should consider visceral ischemic complications in patients with scrub typhus presenting with persistent abdominal pain. Early recognition and timely anti-rickettsial therapy can result in favorable outcomes.